Suturing System

ABSTRACT

A suturing system including apparatus and methods for disposing stitches in a substrate comprising a thread carrier which inserts a thread in the substrate at a first location and withdraws the thread from the substrate at a second location.

I. BACKGROUND

A suturing system including apparatus and methods for disposing stitchesin a substrate comprising a thread carrier which inserts a thread in thesubstrate at a first location and withdraws the thread from thesubstrate at a second location.

II. SUMMARY OF THE INVENTION

Accordingly, a broad object of the present invention is to provide anapparatus including one or more of a suturing probe including a threadcapture chamber disposed adjacent a substrate capture chamber having achamber port open to a suturing probe external surface and a threadcarrier slidingly engaged to the suturing probe which passes outside ofthe substrate capture chamber into the thread capture chamber.

Another broad object of the present invention is to provide a method formaking an apparatus including one or more of disposing in a suturingprobe a thread capture chamber adjacent a substrate capture chamberhaving a chamber port opening to a suturing probe external surface andslidingly engaging a thread carrier in the suturing probe, the threadcarrier passing outside of the substrate capture chamber into the threadcapture chamber.

Another broad object of the present invention is to provide a method ofusing an apparatus including one or more of capturing a substrate in asubstrate capturing chamber of a suturing probe and driving a threadcarrier in the suturing probe toward a thread capture chamber adjacentto the substrate capture chamber, the thread carrier passing through thesubstrate into the thread capture chamber outside the substrate capturechamber.

Naturally, further objects of the invention are disclosed throughoutother areas of the specification, drawings, photographs, and claims.

III. A BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a first perspective view of an embodiment of the suturingapparatus having a thread carrier in a retracted condition.

FIG. 2 is a second perspective view of an embodiment of the suturingapparatus having the thread carrier in an extended condition.

FIG. 3 is a first side elevation view of an embodiment of the suturingapparatus.

FIG. 4 is a top plan view of an embodiment of the suturing apparatus.

FIG. 5 is a second side elevation view of an embodiment of the suturingapparatus.

FIG. 6 is a bottom plan view of an embodiment of the suturing apparatus.

FIG. 7 is an enlarged view of the suturing probe shown in FIG. 1.

FIG. 8 is an enlarged view of the suturing probe shown FIG. 2.

FIG. 9 is an enlarged view of the portion 9 shown in FIG. 3 sideelevation view of a particular embodiment of a suturing probe.

FIG. 10 is an enlarged view of the suturing probe shown in FIG. 10.

FIG. 11 is a cross section view 11-11 as shown in FIG. 4 of a particularembodiment of a suturing probe and a substrate capture chamber insertremoved from a substrate capture chamber.

FIG. 12 is a cross section view 12-12 as shown in FIG. 4 of a particularembodiment of a suturing probe and a substrate capture chamber insertcoupled to a substrate capture chamber.

FIG. 13 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture chamber.

FIG. 14 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture assembly and engaged with thethread capture assembly.

FIG. 15 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture assembly and engaged with thethread capture assembly.

FIG. 16 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture assembly and engaged with thethread capture assembly.

FIG. 17 is a cross section view of a particular embodiment of a suturingapparatus as shown in FIG. 4.

FIG. 18 is an enlarged view of a portion of the cross section of aparticular embodiment of a suturing probe shown in FIG. 17.

FIG. 19 is an enlarged perspective view of a portion of the crosssection of a particular embodiment of a handle shown in FIG. 17.

FIG. 20 is an enlarged view of a cross section 20-20 of a particularembodiment of a tubular member shown in FIG. 4.

FIG. 21 is an enlarged cross section view of a particular embodiment ofan arrest assembly in a thread carrier first position.

FIG. 22 is an enlarged cross section view of a particular embodiment ofan arrest assembly between a thread carrier first position and a threadcarrier second position.

FIG. 23 is an enlarged cross section view of a particular embodiment ofan arrest assembly in a thread carrier second position.

FIG. 24 is a perspective view of a particular embodiment of a suturingapparatus having a thread passing through the thread carrier apertureand disposed in a thread catch.

FIG. 25 is an enlarged perspective view of a thread catch as shown inFIG. 1.

FIG. 26 is an enlarged perspective view of a thread catch as shown inFIG. 1.

FIG. 27 is an enlarged side view of a particular embodiment of a threadcatch.

FIG. 28 is an enlarged plan view of a particular embodiment of a threadcatch.

FIG. 29 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having a thread carrier extended into the thread capturechamber.

FIG. 30 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having a thread carrier engaged with the thread captureassembly.

FIG. 31 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having engaged with the thread capture assembly.

FIG. 32 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having a thread captured by the thread capture assembly.

FIG. 33A is a depiction of a particular method of using a suturingapparatus.

FIG. 33B is a depiction of a particular method of inserting a suturingprobe in a body opening.

FIG. 33C is a depiction of a particular method of palpating a substratetoward a substrate capture chamber.

FIG. 33D is a depiction of a particular method of operating the suturingapparatus to drive the thread carrier through a substrate.

FIG. 33E is a depiction of a particular method of disposing suture loopthe substrate and removing a suturing probe from a body opening.

FIG. 34 is an illustration of a plurality of suture purchases obtainedby use of the suturing apparatus.

IV. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Generally referring to FIGS. 1 through 31, embodiments of a suturingapparatus (1) including a substrate capture chamber (2) and a threadcarrier (3) carrying a thread (4) which axially moves between aretracted condition (5) toward an extended condition (6) in which athread carrier terminal end (7) of the thread carrier (3) passes outsideof the substrate capture chamber (2) into a thread capture chamber (8)to engage a thread capture assembly (9) which captures the thread (4) togenerate a thread loop upon return of the thread carrier (3) toward theretracted condition (5).

Now referring primarily to FIGS. 1 through 10, embodiments of thesuturing apparatus (1) can include a suturing probe (10). The suturingprobe (10) can outward axially extend from a tubular member (11) toterminate in a probe tip (12). The suturing probe external surface (13)can, but need not necessarily, be configured as an extension of theexternal dimensions of the tubular member (11) allowing the probe tip(12) to pass through body openings (14) such as natural body openings orincisions to engage a substrate (15) (as shown in the illustrativeexample of FIGS. 33A through 33E) such as skin, fascia, fat, or muscle.While particular examples of a substrate (15) include tissue (16)including human or animal tissue, this description is not intended topreclude the capture of substrates (15) other than human or animaltissue, including as illustrative examples, cadaver tissue, simulants oftissue, tissue models, elastomer components, plastic or natural fabrics,or the like.

Again referring primarily to FIGS. 1 through 10, in particularembodiments, the suturing probe (10) can have a generally cylindricalsuturing probe external surface (13) terminating in a hebetated probetip (12). As to particular embodiments, the suturing probe externalsurface (13) can include a tapered, beveled, or sloped surfaceapproaching the probe tip (12) to reduce dimensions at the probe tip(12). There can be an advantage in having a sloped, tapered or inclinedprobe face (17) as it allows the suturing probe (10) additional ingressinto a substrate (15) such as animal tissues with a lesser amount oftissue dissection or trauma.

Again, referring primarily to FIGS. 1 through 10, in particularembodiments, a substrate capture chamber (2) can be disposed in thesuturing probe (10). The substrate capture chamber (2) can include achamber sidewall (18) which couples in opposed fixed relation a chamberbottom (19) a distance from said chamber port (20) open to the suturingprobe external surface (13). In particular embodiments, the verticalchamber side wall (18) can define a periphery of greater circumferencethan the periphery of the chamber port (20). In particular embodiments,the substrate capture chamber (2) can, but need not necessarily, befluidically coupled to a vacuum source (21) operable to generate areduced chamber pressure (22) in the substrate capture chamber (2)sufficient to capture, draw, or dispose a substrate (15) into thesubstrate capture chamber (2).

In particular embodiments, the suturing probe (10) can include arecessed portion (23) with the chamber port (20) open to the recessedportion (23) of the suturing probe external surface (13) with the threadcarrier (3) operable to pass within the recessed portion (23) of thesuturing probe external surface (13) outside of the substrate capturechamber (2). In particular embodiments, the recessed portion (23) of thesuturing probe external surface (13) can be arcuate (as shown in theillustrative examples of FIGS. 7 through 9). The arcuate recessedportion (23) of the suturing probe external surface (13) can, but neednot necessarily, be configured to allow a tip of a finger (24) to applyforce to a substrate (15) to move the substrate toward the substratecapture chamber (2) (as shown in the illustrative example of FIG. 33C).

Now referring primarily to FIGS. 7 through 10, the recessed portion (23)of the suturing probe external surface (13) can include a substantiallyflat arcuate face (25). The recessed portion 23 delimits an open areainto which the chamber port (20) opens. A recessed peripheral margin(26) circumscribes an entry of the open area delimited by the recessedportion (23). There can be an advantage in a recessed peripheral margin(26) which affords a substantially flat or lessened curvature about thechamber port (20) in that it can increase the surface area of thesuturing probe external surface (13) contacting a substrate (15). Theincreased surface area of the suturing probe external surface (13) canafford a substantial advantage in capture of a substrate (15) in thoseembodiments in which a reduced chamber pressure (22) can be generated inthe substrate capture chamber (2) or can decrease movement of thesuturing probe (10) in relation to substrate (15) captured in thesubstrate capture chamber (2). As can be seen in the drawings chamberport 20 comprises a transition edge which circumscribes an area lessthan the area circumscribed by peripheral margin (26).

Now referring primarily to FIGS. 1, 2, 4, and 10, the chamber port (20)can, but need not necessarily, be disposed in a stadium configuration(27), being a rectangle with semicircles at a pair of opposite sides.The substrate capture chamber (2) can, but need not necessarily, have achamber bottom (19) in a stadium configuration disposed opposite thechamber port (20) in stadium configuration connected by a substantiallyvertical chamber sidewall (18).

Referring to FIG. 34, there can be an advantage in a substrate capturechamber (2) of stadium configuration (27) in that an increased amount ofsubstrate (15) can be disposed in the substrate capture chamber ascompared to a substrate capture chamber having conventionally slotted orsubstantially circular substrate capture chamber (2) and correspondinglythe substrate (15) penetrated by the thread carrier (3) can dispose athread entry point (28) and a thread withdraw point (29) a greaterdistance apart (also referred to as the “suture purchase (30)) ascompared to conventional slotted or cylindrical suction chambers. Thesuture purchase (30) generated by use of a stadium configuration (27)can be substantially greater than that obtained using a suction chamberof cylindrical configuration or obtained using a conventional suctionchamber of slotted configuration. It may be that the conventionalcylindrical configuration draws the substrate into a conicalconfiguration within the conventional cylindrical suction chamber andthe conventional needle only penetrates the substrate proximate the apexof the cone. It may be that the conventional slotted suction chamberdoes not have sufficient volume to dispose the substrate a sufficientdistance into the conventional slotted chamber and the conventionalneedle only penetrates the substrate layers in adjacent relation closeto the fold or edges.

Now referring to FIGS. 11 and 12, particular embodiments of the suturingprobe can include a substrate capture chamber insert (31). The substratecapture chamber insert (31) can include a substrate capture chamberinsert sidewall (32) which joins a substrate capture insert bottom (33)to a substrate capture chamber insert port (34). The substrate capturechamber insert (31) can be removably coupled to the inside of thesubstrate capture chamber (2) to alter the configuration or volume ofthe substrate capture chamber (2). The altered configuration or volumecorresponding to the substrate capture chamber insert (31) canaccordingly increase or decrease the volume of substrate (15) capturedin the substrate capture chamber (2) and accordingly adjust the suturepurchase (30) (as shown in the illustrative example of FIG. 34). Thesubstrate capture chamber insert (31) can have an insert apertureelement (35) disposed to fluidically couple the internal volume of thesubstrate capture chamber insert (31) and substrate capture chamberinsert port (34) with a first longitudinal channel (36) which couplesthe substrate capture chamber (2) to a vacuum port (37) through whichfluid flow (38) passes to regulate the chamber pressure (22) within thesubstrate capture chamber (2). As shown in the illustrative example ofFIG. 12, the substrate capture chamber insert (31) can have a substratecapture chamber insert bottom (33) which between interchangeableembodiments can be disposed at a depth equal to or less than thedistance between the substrate capture chamber bottom (19) and thechamber port (20). The substrate capture chamber insert port (34) canhave an open area about equal to or less than the open area defined bythe chamber port (20). However, this illustrative example is notintended to preclude other configurations of the substrate captureinsert (31) which can alter only the chamber sidewall (18), only thechamber port (20), or only the chamber bottom (19), or combinationsthereof.

Now referring primarily to FIGS. 13 through 16, a thread captureassembly (9) can be disposed in the thread capture chamber (8). Thethread capture assembly (9) can include at least one resilientlyflexible hook member (39A) correspondingly terminating in at least onehook (40A). The resiliently flexible hook member (39A) can be coupled tothe thread capture chamber internal surface (41) to dispose the hook(40A) at a location to engage the thread carrier (3) and flexing the atleast one resiliently flexible hook member (39A). As to particularembodiments, the thread capture assembly (9) can include a pair ofresiliently flexible hook members (39A)(39B) each correspondinglyterminating in one of a pair of hooks (40A)(40B). The pair ofresiliently flexible hook members (39A)(39B) can each be coupled to thethread capture chamber internal surface (41) to dispose the pair ofhooks (40A)(40B) a distance apart at locations which allow correspondingengagement on opposed sides of the thread carrier (3), thereby flexingeach of the pair of resiliently flexible hook members (39A)(39B) (asshown in the example of FIGS. 13 and 14). Upon retraction of the threadcarrier (3) from the thread capture chamber (8), the pair of resilientlyflexible hook members (39A)(39B) each return toward the unflexedcondition correspondingly disengaging each of the pair of hooks(40A)(40B) from the thread carrier (3).

Again, referring primarily to FIGS. 13 through 16, the thread carrier(3) can further include a notch (42) disposed a distance axially fromthe thread carrier aperture element (43). The notch (42) defines a notchpassage (44) between notch passage first and second ends (45)(46) whichopen on the thread carrier external surface (47). The notch (42) can bedisposed angularly across the thread carrier longitudinal axis (48) ofthe thread carrier (3) to dispose the notch passage first end (45)facing away from the chamber port (20) proximal the thread carrierterminal end (7) and the notch passage second end (46) facing toward thechamber port (20) distal from the thread carrier terminal end (7). Thehook (40A) or the pair of hooks (40A)(40B) engage the thread carrier (3)flexing at least one resiliently flexible hook member (39A) or pair ofresiliently flexible hook members (39A)(39B) and aligning one of thepair of hooks (40A)(40B) with the notch passage second end (46).Resilient flexure moves the hook (40A) into the notch passage second end(46). The hook (40A) travels through the notch passage (44) anddisengages the thread carrier (3) by egress from the notch passage firstend (45).

Now referring primarily to FIGS. 17 through 20, the thread carrier (3)can be coupled to the drive member first end (49) and extend axiallyoutward to terminate in a thread carrier terminal end (7). The threadcarrier (3) can comprise a slender rod which can, but need notnecessarily, taper approaching the thread carrier terminal end (7). Thetaper can be sufficient to allow the thread carrier (3) to pass througha particular type of substrate (15), and as to particular embodiments,the thread carrier (3) can taper to a sharp point at the thread carrierterminal end (7) to pass through a substrate (15) comprising animaltissue. A thread carrier aperture element (43) can be disposed adistance axially from said thread carrier terminal end (7). The threadcarrier aperture element (43) defines a thread carrier aperture (50). Asto particular embodiments, the thread carrier aperture (50) can have athread carrier aperture axis (51) disposed generally orthogonal to thethread carrier longitudinal axis (48) and generally orthogonal to theplane (52) longitudinally bisecting the chamber port (20) (as shown inthe cross section of FIG. 18 which longitudinally bisects the chamberport (20) generally orthogonal to the thread carrier aperture axis(51)).

Now referring primarily to FIGS. 1 through 6, embodiments of thesuturing apparatus (1) can include a housing (53). The housing (53) caninclude a handle (54) and a tubular member (11) which outwardly axiallyextends from the handle (54) terminating in the suturing probe (10). Thehandle external surface (55) can, but need not necessarily, beconfigured to be grippingly engaged by the human hand.

Again, referring primarily to FIGS. 17 through 20, the handle (54) canreceive in axial sliding engagement a thread carrier driver (56). Thethread carrier driver (56) can include an elongate drive member (57)having a length disposed between a drive member first end (49) and adrive member second end (58). The elongate drive member (57) movesaxially inside of the handle (54) in response to a drive member actuator(59). As to particular embodiments, a drive member actuator slot (60)can be disposed in the handle (54) and the drive member actuator (59)can be configured to extend through the drive member actuator slot (60)to present a pressible drive member actuator button (61) which uponforcible urging generates corresponding axial movement of the elongatedrive member (57) inside of the handle (54). As to particularembodiments, the thread carrier driver (56) can be operatedbidirectionally to concurrently reciprocally position the thread carrierterminal end (7) between a thread carrier first position (62) whichlocates the thread carrier terminal end (7) inside of a secondlongitudinal channel (63) which opens to the probe external surface (13)outside of the substrate capture chamber (2) and a thread carrier secondposition (64) with the thread carrier terminal end (7) located in thethread capture chamber (8)(as shown in the examples of FIGS. 7 thorough10). The second longitudinal channel (63) can be fluidically discretefrom the first longitudinal channel (36) coupled to the vacuum source(21). Accordingly, the thread carrier (3) disposed and reciprocallymoved in the second longitudinal channel (63) from the first position(62) to the second position (64) outside of the substrate capturechamber (2) does not require a seal engaging the thread carrier (3) tomaintain reduced chamber pressure (22) in the substrate capture chamber(2) generated in the first longitudinal channel (36) fluidically coupledto the vacuum source (21).

Now referring primarily to FIGS. 17 through 19, the housing (53) can beconfigured to provide a vacuum port (37) opening on the handle externalsurface (55) (as shown in the examples of FIGS. 1 through 6 and 17through19). The vacuum port (37) can be coupled to a vacuum source (21)(as shown in the example of FIGS. 1 and 2). The vacuum source (21) cancomprise any of a variety of conventional vacuum or suction pumps. Thevacuum source (21) can be operated to generate a reduced chamberpressure (22) in the substrate capture chamber (2).

Now referring primarily to FIGS. 21 through 23, the drive member secondend (58) can be coupled to an arrest assembly (65). The arrest assembly(65) can include one or more of an arrest member (66), a prong receiver(67), and a prong (68). The arrest member (66) can have a lengthdisposed between an arrest member first end (69) and an arrest membersecond end (70).

The arrest member first end (69) can be coupled to the thread carrierdriver (56). The arrest member second end (70) can have a taperextending toward the arrest member second end (70). Disposed between thearrest member first and second ends (69)(70) can be a prong receiver(67). The prong receiver (67) can engage the prong (68) which can becoupled to the internal surface (71) of the handle (54). The threadcarrier driver (56) can be operable to concurrently axially move thethread carrier (3) and the arrest member (66). The arrest member (66)can flex, allowing the prong (68) to disengage the prong receiver (67)when the thread carrier driver (56) operates to move the thread carrier(3) toward the thread carrier second position (64). The arrest member(66) can also flex to allow the prong (68) to traverse along the taperof the arrest member second end (70) toward the prong receiver (67),where the prong (68) can engage the prong receiver (67) when the threadcarrier driver (56) operates to move the thread carrier (3) toward thethread carrier first position (62).

Now referring primarily to FIGS. 1 through 11 and 24, a thread (4) canbe disposed in the thread carrier aperture element (43). To assist indisposing the thread (4) in the thread carrier aperture element (43),particular embodiments, can include a thread slot (72). The thread slot(72) can be disposed in the suturing probe (10) adjacent the opening ofthe second longitudinal channel (63) in the suturing probe externalsurface (13). The location of the thread carrier aperture element (43)disposed in the first position (62) can align with the thread slot (72)to permit a thread (4) to be passed through the thread slot (72) and thethread carrier aperture element (43).

Now referring primarily to FIGS. 24 through 28, in particularembodiments, a method in a suturing apparatus (1) can include passing afirst end (73) of a thread (4) through the thread carrier apertureelement (43) disposed on the thread carrier (3). In particularembodiments, the method can further include passing the first end (73)of the thread (4) through the thread carrier aperture element (43) whileit is aligned with the thread slot (72) disposed in the handle (54). Inparticular embodiments, the second end (74) of the thread (4) (or bothends of the thread (4)) can be retained in a thread catch (75) disposedon the handle (54). An embodiment of the thread catch (75) can include athread catch base (76) including a thread catch slot (77) configured tocatch and retain a thread (4). In the embodiment, shown in FIGS. 24through 28, the thread catch (75) can, but need not necessarily include,one or more friction pads (78) disposed in opposed relation about thethread catch slot (77). In particular embodiments, the friction pads(78) can comprise an elastomeric material which increases friction onthe thread (4) when disposed in the thread catch slot (77). Inparticular embodiments, the thread catch (75) can include a thread catchbase (76) including a thread catch aperture element (80). The threadcatch aperture element (80) can define a thread catch aperturecommunicating between a distal end of the thread catch (75) and aproximal end of the thread catch (75). The thread (4) can be passedthrough the thread catch aperture in a distal to proximal direction.

Referring primarily to FIGS. 29 through 32, a method in a suturingapparatus (1) can include driving a thread carrier (3) slidingly engagedto the suturing probe (10) toward the thread capture chamber (8).Slidingly engaging a thread capture assembly (9) disposed in the threadcapture chamber (8) with the thread carrier (3) carrying the thread (4).Disposing the thread (4) adjacent at least one resiliently flexible hookmember (39A) terminating in a hook (40A). Aligning the hook (40A) with anotch second end (46) of the notch (42) disposed in the thread carrier(3) (as shown in the examples of FIGS. 29 and 30). Driving the threadcarrier (3) slidingly engaged to the suturing probe (10) away from thethread capture chamber (8) to move the hook (40A) through the notchpassage (44). Capturing the thread (4) on the hook (40A) (as shown inthe example of FIGS. 31 and 32).

Now referring primarily to FIG. 33A through 33E, a method in a suturingapparatus (1) can include passing a first end (73) of a thread (4)through the thread carrier aperture element (43) disposed on the threadcarrier (3) (as shown in the example of FIG. 33A). Inserting a suturingprobe (10) into a body opening (14) of a substrate (15) (as shown in theexample of FIG. 33 B). Forcibly urging the substrate (15) toward asubstrate capture chamber (2) disposed in the suturing probe (10) whichas to particular embodiments, includes contacting the substrate (15)with a finger (24) or other instrument or device (as shown in theexample of FIG. 33C). Capturing the substrate (15) in the substratecapture chamber (2), which can, but need not necessarily, includegenerating a reduced chamber pressure (22) in the substrate capturechamber (2) by operation of a vacuum source (21) to draw and retain anamount of the substrate (15) in the substrate capture chamber (2).Driving a thread carrier (3) slidably engaged in the suturing probe (10)toward a thread capture chamber (8). Passing the thread carrier (3)carrying the thread (4) through the substrate (15) outside of thesubstrate capture chamber (2) into the thread capture chamber (8) (asshown in the example of FIG. 33D). Engaging the thread carrier (3) witha thread capture assembly (9) disposed in the thread capture chamber(8). Capturing the thread (4) on the thread capture assembly (9).Reciprocally driving a thread carrier (3) from the thread capturechamber (8) and through the substrate (15) to generate a thread loop inthe substrate (15) (as shown in the example of FIG. 33E). In particularembodiments, the methods can further include inserting a substratecapture chamber insert (31) into the substrate capture chamber (2).

With regards to driving a thread carrier (3) in the suturing probe (10)toward a thread capture chamber (8), the method can further includepressing a drive member actuator button (61) extending through the drivemember actuator slot (60) in a handle (54) of the suturing apparatus(1). The pressing can generate movement in the thread carrier (3) in afirst direction (79) toward the thread capture chamber (8). The movementof the thread carrier (3) in a first direction (79) can pass the threadcarrier (3) through the substrate (15) outside of the substrate capturechamber (2) into the thread capture chamber (8) without compromising theintegrity of the reduced chamber pressure (22) generated by a vacuumsource (21) fluidically coupled to the substrate capture chamber (2). Inparticular embodiments, the method can further include flexing an arrestassembly (65), thereby disengaging the prong (68) from the prongreceiver (67) and advancing the prong (68) along the taper of the arrestmember second end (70) and to permit the movement of the thread carrier(3) in the first direction (79).

Now referring primarily to FIG. 34, there can be an advantage in varyingthe configuration or volume of the substrate capture chamber (2).Various configurations and volumes of the substrate capture chamber (2)can by utilizing a substrate capture chamber insert (31) and the optionof utilizing a vacuum source (21) to reduce pressure (22) in thesubstrate capture chamber (2) correspondingly vary, the suture purchase(30) in the substrate (15, 16) depending on the requirements of theapplication. In particular embodiments which include a vacuum source(21), reducing pressure (22) in the substrate capture chamber (2) cancapture an increased amount of substrate (15) in the substrate capturechamber (2), thereby increasing the suture purchase (30). The suturepurchase (30) can be adjusted by the use of a substrate capture chamberinsert (31) which varies the volume of the substrate capture chamber (2)available to receive the substrate (15). In other particularembodiments, a substrate capture chamber insert (31) can be utilizedwithout a vacuum source (21), decreasing the suture purchase (30) asopposed to an application which utilizes a vacuum source (21). Thus, byaltering the factors of utilizing a substrate capture chamber insert(31) and the utilization of a vacuum source (21), the suture purchase(30) can be increased or decreased depending upon the application.

As can be easily understood from the foregoing, the basic concepts ofthe present invention may be embodied in a variety of ways. Theinvention involves numerous and varied embodiments of a mountablecarrier and methods for making and using such mountable carrierincluding the best mode.

As such, the particular embodiments or elements of the inventiondisclosed by the description or shown in the figures or tablesaccompanying this application are not intended to be limiting, butrather exemplary of the numerous and varied embodiments genericallyencompassed by the invention or equivalents encompassed with respect toany particular element thereof. In addition, the specific description ofa single embodiment or element of the invention may not explicitlydescribe all embodiments or elements possible; many alternatives areimplicitly disclosed by the description and figures.

It should be understood that each element of an apparatus or each stepof a method may be described by an apparatus term or method term. Suchterms can be substituted where desired to make explicit the implicitlybroad coverage to which this invention is entitled. As but one example,it should be understood that all steps of a method may be disclosed asan action, a means for taking that action, or as an element which causesthat action. Similarly, each element of an apparatus may be disclosed asthe physical element or the action which that physical elementfacilitates. As but one example, the disclosure of a “mount” should beunderstood to encompass disclosure of the act of “mounting”—whetherexplicitly discussed or not—and, conversely, were there effectivelydisclosure of the act of “mounting”, such a disclosure should beunderstood to encompass disclosure of a “mount” and even a “means formounting.” Such alternative terms for each element or step are to beunderstood to be explicitly included in the description.

In addition, as to each term used it should be understood that unlessits utilization in this application is inconsistent with suchinterpretation, common dictionary definitions should be understood to beincluded in the description for each term as contained in the RandomHouse Webster's Unabridged Dictionary, second edition, each definitionhereby incorporated by reference.

All numeric values herein are assumed to be modified by the term“about”, whether or not explicitly indicated. For the purposes of thepresent invention, ranges may be expressed as from “about” oneparticular value to “about” another particular value. When such a rangeis expressed, another embodiment includes from the one particular valueto the other particular value. The recitation of numerical ranges byendpoints includes all the numeric values subsumed within that range. Anumerical range of one to five includes for example the numeric values1, 1.5, 2, 2.75, 3, 3.80, 4, 5, and so forth. It will be furtherunderstood that the endpoints of each of the ranges are significant bothin relation to the other endpoint, and independently of the otherendpoint. When a value is expressed as an approximation by use of theantecedent “about,” it will be understood that the particular valueforms another embodiment. The term “about” generally refers to a rangeof numeric values that one of skill in the art would consider equivalentto the recited numeric value or having the same function or result.Similarly, the antecedent “substantially” means largely, but not wholly,the same form, manner or degree and the particular element will have arange of configurations as a person of ordinary skill in the art wouldconsider as having the same function or result. When a particularelement is expressed as an approximation by use of the antecedent“substantially,” it will be understood that the particular element formsanother embodiment.

Moreover, for the purposes of the present invention, the term “a” or“an” entity refers to one or more of that entity unless otherwiselimited. As such, the terms “a” or “an”, “one or more” and “at leastone” can be used interchangeably herein.

Thus, the applicant(s) should be understood to claim at least: i) eachof the mountable carriers herein disclosed and described, ii) therelated methods disclosed and described, iii) similar, equivalent, andeven implicit variations of each of these devices and methods, iv) thosealternative embodiments which accomplish each of the functions shown,disclosed, or described, v) those alternative designs and methods whichaccomplish each of the functions shown as are implicit to accomplishthat which is disclosed and described, vi) each feature, component, andstep shown as separate and independent inventions, vii) the applicationsenhanced by the various systems or components disclosed, viii) theresulting products produced by such systems or components, ix) methodsand apparatuses substantially as described hereinbefore and withreference to any of the accompanying examples, x) the variouscombinations and permutations of each of the previous elementsdisclosed.

The background section of this patent application provides a statementof the field of endeavor to which the invention pertains. This sectionmay also incorporate or contain paraphrasing of certain United Statespatents, patent applications, publications, or subject matter of theclaimed invention useful in relating information, problems, or concernsabout the state of technology to which the invention is drawn toward. Itis not intended that any United States patent, patent application,publication, statement or other information cited or incorporated hereinbe interpreted, construed or deemed to be admitted as prior art withrespect to the invention.

The claims set forth in this specification, if any, are herebyincorporated by reference as part of this description of the invention,and the applicant expressly reserves the right to use all of or aportion of such incorporated content of such claims as additionaldescription to support any of or all of the claims or any element orcomponent thereof, and the applicant further expressly reserves theright to move any portion of or all of the incorporated content of suchclaims or any element or component thereof from the description into theclaims or vice-versa as necessary to define the matter for whichprotection is sought by this application or by any subsequentapplication or continuation, division, or continuation-in-partapplication thereof, or to obtain any benefit of, reduction in feespursuant to, or to comply with the patent laws, rules, or regulations ofany country or treaty, and such content incorporated by reference shallsurvive during the entire pendency of this application including anysubsequent continuation, division, or continuation-in-part applicationthereof or any reissue or extension thereon.

Additionally, the claims set forth in this specification, if any, arefurther intended to describe the metes and bounds of a limited number ofthe preferred embodiments of the invention and are not to be construedas the broadest embodiment of the invention or a complete listing ofembodiments of the invention that may be claimed. The applicant does notwaive any right to develop further claims based upon the description setforth above as a part of any continuation, division, orcontinuation-in-part, or similar application.

1. A method of making a suturing probe comprising: recessing an externalsurface of said suturing probe to form a recessed external surface;delimiting an open area with said recessed external surface; openinginto said open area a thread capture chamber; opening into said openarea a substrate capture chamber; forming a chamber port having acontinuous transition edge; delimiting an entry into the substratecapture chamber with said continuous transition edge of said chamberport; opening said chamber port to said suturing probe recessed externalsurface; circumscribing a first area with said transition edge;delimiting an entry to said open area at a peripheral margin of saidopen area; circumscribing a second area with said peripheral margin,said first circumscribed area less than said second circumscribed area;and slidingly engaging a thread carrier to said suturing probe, saidthread carrier engaged to pass outside said substrate capture chamberinto said thread capture chamber.
 2. The method of making the suturingprobe of claim 1, further comprising: engaging said thread carrier topass within said suturing probe recessed external.
 3. The method ofmaking the suturing probe of claim 2, further comprising: disposing athread carrier aperture element proximate a thread carrier terminal end;and defining with said thread carrier aperture element a thread carrieraperture communicating between opposed aperture openings on a threadcarrier external surface.
 4. The method of making the suturing probe ofclaim 3, further comprising: disposing a thread slot in a suturing probeexternal surface; and aligning said thread carrier aperture with saidthread slot to pass a thread through said thread carrier aperture. 5.The method of making the suturing probe of claim 4, further comprising:configuring said thread carrier aperture to have an aperture axisgenerally orthogonal to a longitudinal axis of said thread carrier. 6.The method of making the suturing probe of claim 5, further comprising:coupling a chamber sidewall in opposed fixed relation to a chamberbottom surface; and fixing said chamber bottom a distance from saidchamber port.
 7. The method of making the suturing probe of claim 6,further comprising: removably coupling a substrate capture chamberinsert inside of said substrate capture chamber; and disposing, at adepth, said substrate capture chamber insert bottom less than saiddistance between said chamber bottom and said chamber port.
 8. Themethod of making the suturing probe of claim 7, further comprising:configuring said substrate capture chamber insert to have a substratecapture chamber insert entry open to said external surface of saidsuture probe; and configuring said substrate capture insert port to havean open area equal to or less than an open area defined by said chamberport.
 9. A method of making a suturing probe comprising: disposing athread capturing chamber adjacent a substrate capture chamber;configuring a chamber of said substrate capture chamber to open to asuturing probe external surface; slidingly engaging a thread carrier tosaid suturing probe, said thread carrier engaged to pass outside saidsubstrate capture chamber into said thread capture chamber, said threadcarrier having an external surface; removably coupling a substratecapture chamber insert inside of said substrate capture chamber;disposing a bottom of said substrate capture chamber insert at a depthless than the distance between a chamber bottom of said substratecapture chamber and a chamber port of said substrate capture chamber;orienting a substrate capture chamber insert entry to open to saidexternal surface of said suture probe; configuring a substrate capturechamber insert port of said substrate capture chamber insert to have anopen area less than an open area defined by said chamber port; andforming said chamber insert entry to have a stadium configuration. 10.The method of making the suturing probe of claim 9, further comprising:forming said substrate capture chamber insert bottom and said substratecapture chamber insert port to each have a stadium configuration. 11.The method of making the making suturing probe of claim 9, furthercomprising: disposing a notch in a thread carrier external surface ofsaid thread carrier; defining with said notch a passage between a notchpassage first end and a notch passage second end, said notch passageopen on said thread carrier external surface; and angularly disposingsaid notch across a longitudinal axis of said thread carrier to disposesaid notch passage first end proximate a thread carrier terminal end andto dispose said notch passage second end distal said thread carrierterminal end.
 12. The method of making the suturing probe of claim 11,further comprising: disposing a thread capture assembly within saidthread capture chamber, said thread capture assembly including at leastone resiliently flexible hook member terminating in a hook; orientingsaid hook disposed in said thread capture chamber to engage with saidthread carrier to flex said at least one resiliently flexible hookmember; aligning said hook with said notch second end to move into saidnotch passage; and orienting said hook to disengage with said threadcarrier by egress from said notch first end.
 13. The method of makingthe suturing probe of claim 12, further comprising: orienting said hookto disengage said thread carrier by egress from said notch first end tocapture a thread to retain a thread loop.
 14. The method of making thesuturing probe of claim 11, further comprising: disposing a threadcapture assembly in said thread capture chamber, said thread captureassembly including a pair of resiliently flexible hook memberscorrespondingly terminating in one of a pair of hooks; orienting saidpair of hooks disposed in said thread capture chamber to engage withsaid thread carrier to flex said pair of resiliently flexible hookmembers; aligning one of said pair of hooks with said notch second endto move into said notch passage; and orienting said hook to disengagewith said thread carrier by egress from said notch first end.
 15. Themethod of making the suturing probe of claim 14, further comprising:coupling a tubular member first end of a tubular member to said suturingprobe; and coupling a tubular member second end of said tubular memberto a handle.
 16. The method of making the suturing probe of claim 15,further comprising: disposing a thread catch on said handle; andorienting said thread catch to releasably retain said thread.
 17. Themethod of making the suturing probe of claim 11, further comprising:coupling a thread carrier driver to said thread carrier opposite saidthread carrier terminal end; and orienting said thread carrier torespond to said thread carrier driver by passing outside of saidsubstrate capture chamber and into said thread capture chamber uponactuation of said thread carrier driver.
 18. The method of making thesuturing probe of claim 17, further comprising: extending a threadcarrier driver actuator through a drive member actuator slot in a handlecoupled to said suturing probe; and providing a pressable drive memberactuator button coupled to said thread carrier driver.
 19. The method ofconfiguring the suturing probe of claim 18, further comprising: couplingan arrest assembly to said thread carrier driver, said arrest assemblyincluding: a length disposed between an arrest member first end coupledto said thread carrier driver and an arrest member second end having ataper extending toward said arrest member second end; a prong receiverdisposed between said arrest member first and second ends; and a prongcoupled to an internal surface of said handle, said prong engageablewith said prong receiver; orienting said thread carrier driver toconcurrently axially move said thread carrier and said arrest memberupon actuation of said thread carrier driver, and to flex said arrestmember to allow said prong to disengage said prong receiver uponactuation of said driver; and orienting said prong of said arrestmember, upon actuation of said driver, to traverse along said taper ofsaid arrest member second end to dispose said thread carrier in a firstthread carrier position inside of said thread capture chamber.
 20. Themethod of making the suturing probe of claim 19, further comprising:disposing said arrest member to flex to allow said prong to traversealong said taper of said arrest member second end toward said prongreceiver upon actuation of said driver, and to engage said prongreceiver.